Provider Demographics
NPI:1396965414
Name:SHAO, LEYUN (AP)
Entity type:Individual
Prefix:DR
First Name:LEYUN
Middle Name:
Last Name:SHAO
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 W VIRGINIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6357
Mailing Address - Country:US
Mailing Address - Phone:813-872-4868
Mailing Address - Fax:813-872-4868
Practice Address - Street 1:2815 W VIRGINIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6357
Practice Address - Country:US
Practice Address - Phone:813-872-4868
Practice Address - Fax:813-872-4868
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL611171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist